On 2017 Aug 11, Jos Verbeek commented:

Unfortunately this review did not adhere to the following important Cochrane standards. There was no published protocol. The authors combined the results of all RCTs and case series thus artificially inflating the effect. They pooled very different interventions in one pooled result even though heterogeneity was as high as 82%. I believe that calculating one pooled effect size for interventions as different as meditation, communication skills or improved work schedules does not make sense. It is also not a methodological standard to loosely asses the quality of the evidence as moderate without further justification and not using the GRADE approach. Another interesting item is the claim that the results are ‘clinical meaningful reductions’. It is not clear what the authors refer to. With patient-reported outcomes one would be interested in a minimally clinically relevant difference or reductions that patients perceive as an improvement. However, for the Maslach Burnout Inventory this difference has never been established as far as we know. Thus we don’t know what the clinical meaning of reductions on this scale is. It is very well conceivable that these will not be perceived as improvements by an individual health care worker. West et al neither discuss the problem of small studies that is apparent with the average number of participants being less than 50 in the 15 included trials but again loosely refer to the funnel plot as not indicating publication bias. I believe that physicians are put on the wrong foot with the conclusion of moderate quality evidence of clinically meaningful reductions in burnout based on this review.

On 2017 Aug 11, Jos Verbeek commented:

Unfortunately this review did not adhere to the following important Cochrane standards. There was no published protocol. The authors combined the results of all RCTs and case series thus artificially inflating the effect. They pooled very different interventions in one pooled result even though heterogeneity was as high as 82%. I believe that calculating one pooled effect size for interventions as different as meditation, communication skills or improved work schedules does not make sense. It is also not a methodological standard to loosely asses the quality of the evidence as moderate without further justification and not using the GRADE approach. Another interesting item is the claim that the results are ‘clinical meaningful reductions’. It is not clear what the authors refer to. With patient-reported outcomes one would be interested in a minimally clinically relevant difference or reductions that patients perceive as an improvement. However, for the Maslach Burnout Inventory this difference has never been established as far as we know. Thus we don’t know what the clinical meaning of reductions on this scale is. It is very well conceivable that these will not be perceived as improvements by an individual health care worker. West et al neither discuss the problem of small studies that is apparent with the average number of participants being less than 50 in the 15 included trials but again loosely refer to the funnel plot as not indicating publication bias. I believe that physicians are put on the wrong foot with the conclusion of moderate quality evidence of clinically meaningful reductions in burnout based on this review.